Surgeons insert tube to help pope breathe

Tracheotomy can be used to administer oxygen or suction out secretions

February 25, 2005|By Erika Niedowski | Erika Niedowski,SUN STAFF

It was a standard 30-minute hospital procedure, but it grabbed the world's attention overnight.

Doctors in Rome performed a tracheotomy yesterday on Pope John Paul II - making an incision in his neck below the larynx and inserting a tube that can provide oxygen to his lungs and help clear fluids or other obstructions from his airway.

The 84-year-old pontiff reportedly was breathing with the help of a mechanical ventilator. A Vatican spokesman described yesterday's procedure as "elective" and said the surgery had had a "positive" outcome.

Though physicians who are not treating the pope refused to speculate on how fragile his condition might be, they said the tracheotomy goes a step beyond a nonsurgical intubation - the least-invasive method of helping a patient breathe.

"They want to have a way to reliably keep his airway open," said Dr. Wayne M. Koch, a head and neck surgeon at the Johns Hopkins Hospital.

Doctors have noted that a flu-like illness or pneumonia would likely worsen breathing and swallowing problems the pope may already have developed because of Parkinson's disease.

Koch said the tracheotomy tube can be used not only to administer oxygen, but also to suction out thick secretions that might be blocking his airway.

A tracheotomy, also known as a tracheostomy, typically takes about 20 minutes and can be performed under a local or a general anesthetic. Sometimes, to place the tube in the windpipe, doctors have to partially move or separate the thyroid gland, which can cause minor bleeding.

Before resorting to a tracheotomy, doctors usually try to intubate, which consists of running a tube through a patient's mouth, down over the larynx and into the trachea.

"They would want to do a tracheostomy now, as opposed to put the breathing tube in first, because the narrowing or the inflammation or the blockage below the larynx is so significant that you don't think you can pass a breathing tube through there," said Dr. Rodney J. Taylor, a head and neck surgeon at the University of Maryland Medical Center, who performs several tracheotomies a week.

Some patients who undergo the procedure can breathe without assistance through the tube in their throat.

Chief Justice William H. Rehnquist, who underwent a tracheotomy in October as part of his treatment for thyroid cancer, administered the oath of office to President Bush last month with his breathing tube in place.

The scare over the pope's health occurred much like one earlier this month - with a hurried trip to Gemelli Polyclinic Hospital in Rome. The pope was hospitalized Feb. 1 as a precaution, aides said, after he developed trouble breathing, apparently the result of a case of influenza.

At the time, he was said to be suffering from tracheitis - an inflammation of the trachea - and spasms of the larynx.

Since his release two weeks ago, the pope has made several public appearances, including two from the window of his studio in St. Peter's Square.

Concerns over the pope's health have been growing for years. The Vatican confirmed two years ago what many had long suspected - that Pope John Paul has Parkinson's disease. The progressive, degenerative neurological disorder, which leads to loss of control over body movements, has made it difficult for him to speak and walk.

The pope, who also suffers from crippling knee and hip ailments, has appeared increasingly frail in recent years. He typically celebrates Mass while seated in a special chair and has missed a number of appearances because of poor health.

This month, he was forced to skip his first Ash Wednesday service at St. Peter's Basilica since he assumed the papacy 26 years ago, instead blessing ashes from his hospital room.

The Vatican often plays down the pope's illnesses, but he addressed his mortality in the spring of 2003, saying: "I am increasingly aware that the day is drawing near when I will have to present myself to God and make an accounting of my whole life."

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